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Permit City of Tigard • t:c)NtyIIPN1"fY I)VVLI.t)PMII'N't' IWP,vR"1`M1I,N'I` Re cl �C.°.uest for ert-rut Action. k 0 I 1 Ic;A II,I'> 1:3125 SW 11311 kilt'&, • t'il ard,C1reo to 'I722°`3+ SIft7I8-2439 `WAVAyli;af d,,, ,,;oi.,, v/V;3.—/ d TO: CITY OF TIGARI) Building Division 13125 SW I fall Blvd.,Tigard,OR 97223 Plume: 50i,718,21:39 Pax: 503-5914 1r961) °I'igartllinilclnigPernntr:(cfitn,,irtl (Hg(av FROM: 0 Owner `'.1pplicant El Contractor 0 t:ii St,lfi° REFUND OR Name: �/ ){J�J 11�)Y OICE pro: 1140141010 11K 117..t41'i61i1111 ov. e,f- Mailing Address: ._ . .. ._ C c(� fOa— Phone No,: �✓ c " es\ PLEASE TAKE ACTION FOR U ITEM(S)CIIECKED(✓): f:,'\Nt;1.1,/Vf►II) P1',R\1F1',1PP1i( .1'I"IC)N. ..a RI:.Fxi NI)P11. 011 11:1%1 IS (attach carp\ of original receipt and provide explanation below). I INVOR:Ia,I°t At I I,I',, (attach c'a,se fee schedule and provide e larra+i n l t'errriuJ: fin t S site ‘dd fess or Parcel t°): G ? Project Name: i.1C5 13t.. .rit144VrIrtl-P( v+b 1 Subdivision Name: 10t. : EXPLANATION: ' w., P 'l.t%, '?._` J. __.... ' .�:riAt v1T� ° ,r I t e 4 tiil3rr�l rt re: Date: 2 Print Name: �. � 1 "lhe end';t �,rnntuatit+ Uccaia�lxttacnt CJircc3oa,liuilttu,l trd t)frt.isal ur t"upy t°°trl+lnkct ma), rntt44rriac rirr t.rtiut.t r4[ �� • 44s}'is aIaicla'ut t-rto(renndp p,ti<I or cnllecreti. • \ul nl=w, sit, i fart"-,,of" i1,t atiuu i Islam tcglcw fee when to u1tph4.410s111 i rt`iittctt,tu;n 411 eancctcd fstsfore nflorr rt 411 cRpGnelcet • 1,03 u I i than 80'ra ii ncc,appliiutton ur peril(feet lisr Inanct.1 pertntls lnn,r to,mt nt,arecttoit et9Utr u: �1i1 al fnar.lt ze III Ile trtnln ii)o thr urtltin,tt 1(1(1(1 of.1 t beck pia t I)eviruI u°t1'Ie t'€e 1.+vo;tsls for plim'ahmf,tefunJ aerftre ts, I'I)R 01''F10E ItSE ONLY Runic u,So yAdiftur Date I1 Route 10 Iftcurti4 Date' ► Tio: Itt ./ 12t'funtl l'rott.I I nc Itl latttntt l'nttcasi%I I>ut i„ Pcnnnf ntecictl I)ticdZ 14t40,230I'trttlTat4 laltit4tl Matt ltt lsl d4v1},',7,; ;;74i,. 1i't,rnul.le u•,u t a s s 111 q TIGARD City of Tigard February 4,2021 Robert Serrano 7958 SW 28th Ave Portland, OR 97219 Re: Permit No. SWR2020-00169 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11642 SW Pacific Hwy Project Name: Brick's Barber Shop Job No.: N/A Refund Method: ® Check#238164 in the amount of$1,450.00. ❑ Credit card"return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Refund sewer connection fees paid per applicant's request as they decided to use a different suite. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Ornelas Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov IN City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use,development engineering and building permit application fees. Receipts, documentation and the Reguestfor Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE Robert Serrano DATE: 2/1/2021 TO: 7958 SW 28th Ave Portland, OR 97219 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 431515 Case#: SWR2020-00169 Date: 10/22/2020 Address/Parcel: 11642 SW Pacific Hwy, 140 Pay Method: CreditCard Project Name: Brick's Barber Shop EXPLANATION: Per applicant's request as they voided the plumbing permit and sewer permits and will not be using the space for this tenant. Refund 80%of permit fees paid. REFUND INFORMATION: Fee Description From Receipt. Revenue Account No. Refund Pcan-p1e:. Building Permit Fee Example: 2300000-43104 $Amount 500-0000-25500 $1,450.00 TOTAL REFUND: $1,450.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff ,.,,, ' If under$12,500 Division Manager D. L. OVV 1G(. If under$25,000 Department Manager If under$100,000 City Manager I If over$50,000 Local Contract Review Board i�.g$yy�' �P",7 '£..SJh4' t�f'� AcA R sywkom iUTRAT . st r �67 tt "�sq 4 44 Ytto, {kart e �« r t3ItiNty(c- Fm fl. , Case Refund Processed: Date: 9/S/� By: I I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 111111 I 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 if GAP.D Project Name: Brick's Barber Shop Site Address: 11642 SW PACIFIC HWY 140 /I�^�/u e✓ Receipt Number: 436245 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2020-00169 $-1,450.00 Total: $-1,450.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238164 DHOWSE 09/03/2021 $-1,450.00 Payor: Robert Serrano Total Payments: $-1,450.00 Balance Due: $1,450.00 CITY OF TIGARD RECEIPT if a . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARLD Project Name: Brick's Barber Shop Site Address: 11642 SW PACIFIC HWY 140 Receipt Number: 431515 - 10/22/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2020-00169 Sewer Connection Fee 500-0000-25500 $1,450.00 Total: $1,450.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6947268 PUBLICUSERO 10/22/2020 $1,450.00 Payor: Total Payments: $1,450.00 Balance Due: $0.00 o"„o . .-. Branden Taggart From: Branden Taggart Sent: Wednesday, December 2, 2020 11:39 AM To: Robert Serrano Subject: RE: Refund Attachments: Scanned Documents.pdf Hi Robert, Per our phone conversation, I have forwarded this Request for Permit Action form to my supervisor for a refund. A refund check will be received in the mail in approximately 6-8 weeks. Thanks, Branden Taggart q City of Tigard s u ' Senior Permit Technician Community Development TIQM 13125 SW Hall Blvd Tigard,OR 97223 (503)718-2449 brandent@tigard-or,gov From: Robert Serrano<robear.serrano@gmail.com> Sent:Tuesday, November 24, 2020 10:53 AM To: Branden Taggart<brandent@tigard-or.gov> Subject: Re: Refund Caution! This message was sent from outside your organization. Allow sender Block sender I'm not sure if the construction company paid the permit fees or if I did. I know for sure I did pay the $$1450 plus processing fee on my discover card. Please let me know if you need anything else from me to process the refund and also the amount I can expect to get back.Thank you Rob Serrano (503) 975 3127 On Nov 16, 2020, at 11:13 AM, Branden Taggart<brandent@tigard-or.gov>wrote: Hi Robert, Per our phone conversation, we will process a refund after we receive a completed Request for Permit Action form. Please see the link below for the form: https://www.tigard-or.gov/document center/Building/Reg PermitAction.pdf 1 Thanks, City of Tigard Senior Permit Technician Community Development Branden Taggart 13125 SW Hall Blvd Tigard, OR 97223 DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention 8ohedu|e." illq CITY OF TIGARD SEWER CONNECTION PERMIT 11 ..' COMMUNITY DEVELOPMENT Permit#: SWR2020-00169 TLAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2020 G Parcel: 1 S136DB02400 Jurisdiction: TIGARD Site address: 11642 SW PACIFIC HWY 140 Project: Brick's Barber Shop Subdivision: AZOIC TERRACE Lot: 1 Project Description: .25 EDU increase. Contractor: Owner: CHAMPION, RONALD V&ROBERTA E 16449 LEXINGTON CT LAKE OSWEGO, OR 97034 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 10/22/2020 $1,450.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .25 Total $1,450.00 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: 4e Ca 503.639.4175 by 7:00 a.m.for the next available inspection date. �— This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection.